Breast Chemotherapy Regimens

The information contained in these regimens is a statement of consensus of NCCP and ISMO or IHS professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. The treatment regimen to be used should take into account factors such as histology, molecular pathology, age, performance status, co-morbidities and the patient’s preference. Each treatment regimen has advantages and disadvantages, and there may be more than one good option.  In addition, treatment choices can change over time as more evidence becomes available. Use of these documents is the responsibility of the prescribing clinician and is subject to the HSE.ie terms of use.

Please email any comments or feedback on these regimens to oncologydrugs@cancercontrol.ie

Oncotype-DX

Use of Oncotype DX for gene expression profiling to support chemotherapy decision making was recommended by the NCCP Technology Review Committee in August 2011 in line with these eligibility guidelines drafted by the Irish Society of Medical Oncology.

Information on Oncotype-DX® gene expression profile and chemotherapy decision-making in patients with early stage breast cancer is available here.

 

Breast Chemotherapy Regimens

Adjuvant treatments

Regimen Name Indication

Anastrozole

Regimen

00254b

Adjuvant treatment of hormone receptor positive early invasive breast cancer in post-menopausal women.

00254c

Adjuvant treatment of hormone receptor-positive early invasive breast cancer in postmenopausal women who have received 2 to 3 years of adjuvant tamoxifen.

Carboplatin (AUC6) and Weekly Paclitaxel (80mg/m2) followed by Dose Dense DOXorubicin Cyclophosphamide Therapy-Triple Negative Breast Cancer Therapy

Regimen

00348a

Neoadjuvant treatment of triple negative breast carcinoma.

Cyclophosphamide (oral) Methotrexate and 5-Fluorouracil (CMF) Therapy

Regimen

00377a

Adjuvant treatment for breast carcinoma in patients who are considered unsuitable for anthracycline therapy.

Cyclophosphamide (IV) Methotrexate and 5-Fluorouracil (CMF) Therapy  21 day

Regimen

00381a

Adjuvant treatment for breast carcinoma in patients who are considered unsuitable for anthracycline therapy.

Cyclophosphamide (IV) Methotrexate and 5-Fluorouracil (CMF) Therapy  28 day

Regimen

00378a

Adjuvant treatment for breast carcinoma in patients who are considered unsuitable for anthracycline therapy.

Docetaxel/Cyclophosphamide (TC) Therapy

Regimen

00250a

Adjuvant treatment of patients withhigh risk node-positive or node-negative early operable breast cancer.

Docetaxel, Carboplatin and Trastuzumab (TCH)-21 days

Regimen

00258a

Adjuvant treatment HER2 positive early breast cancer.

Doxorubicin and Cycophosphamide

Regimen

00252a

Adjuvant Treatment of High Risk Node Negative or Node Positive Breast Cancer

Dose Dense Doxorubicin, Cyclophosphamide followed by Paclitaxel Therapy (AC-T)

Regimen

00278a

Adjuvant treatment of High Risk Node Negative or Node Positive Breast Cancer

00278b

Neoadjuvant treatment of High Risk Node Negative or Node Positive Breast Cancer

Dose Dense Doxorubicin, Cyclophosphamide followed by Paclitaxel (14 days) and Trastuzumab Therapy*

Regimen

00316a

Adjuvant Treatment of HER2 positive, High Risk Node Negative or Node Positive Breast Cancer.

00316b

Neoadjuvant Treatment of HER2 positive, High Risk Node Negative or Node Positive Breast Cancer.

Doxorubicin, Cyclophosphamide followed by weekly Paclitaxel Therapy (AC-T)

Regimen

00260a

Adjuvant Treatment of High Risk Node Negative or Node Positive Breast Cancer

Epirubicin 90 + Cyclophosphamide (EC90) Therapy

Regimen

00262a

Adjuvant treatment for operable breast carcinoma

Exemestane Monotherapy

Regimen

00376a

Adjuvant treatment of postmenopausal women with hormone receptor positive invasive early breast cancer.

00376b

Extended adjuvant treatment of hormone-dependent invasive breast cancer in postmenopausal women who have received prior adjuvant endocrine therapy.

Fluorouracil + Epirubicin 100 + Cyclophosphamide (FEC 100) Therapy

Regimen

00265a

Neoadjuvant treatment for breast carcinoma

00265b

Adjuvant treatment for breast carcinoma

Letrozole Monotherapy

Regimen

00371a

Adjuvant treatment of postmenopausal women with hormone receptor positive invasive early breast cancer.

00371b

Extended adjuvant treatment of hormone-dependent-invasive breast cancer in postmenopausal women who have received prior adjuvant endocrine therapy for 5 years.

00371d

Neo-adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

Tamoxifen

Regimen

00253a

Adjuvant treatment of oestrogen receptor positive breast cancer in pre- or post-menopausal women.

Trastuzumab (IV) Monotherapy - 21 days

Regimen

00200b

The treatment of patients with HER2 positive early breast cancer (EBC).

Trastuzumab Subcutaneous 21 days - Early Breast Cancer

Regimen

HER2 positive early breast cancer (EBC)

00285a

Following surgery, chemotherapy (neoadjuvant or adjuvant) and radiotherapy (if applicable)

00285b

Following adjuvant chemotherapy with doxorubicin and cyclophosphamide, in combination with paclitaxel or docetaxel

00285c

In combination with adjuvant chemotherapy consisting of docetaxel and carboplatin.

00285d

In combination with neoadjuvant chemotherapy followed by adjuvant trastuzumab therapy, for locally advanced (including inflammatory) disease or tumours > 2 cm in diameter

 * Unlicensed indication. See protocol for more details.

Locally Advanced Regimens

Protocol Name Indication

Anastrozole

Regimen

00254a

Treatment of hormone receptor positive locally advanced or metastatic breast cancer in post-menopausal women

Capecitabine Monotherapy

Regimen

00216a

Treatment of metastatic breast cancer.

CARBOplatin (AUC 4-6) Monotherapy- 21 day

Regimen

00261j*

Metastatic breast carcinoma.

CARBOplatin (AUC 4-6) Monotherapy- 28 day

Regimen

00251j*

Metastatic breast carcinoma.

Docetaxel Monotherapy 100mg/m2 – 21 day cycle

Regimen

00202a

Docetaxel monotherapy is indicated for the treatment of patients with locally advanced or metastatic breast cancer.

DOXOrubicin 50mg/m2/Docetaxel 75mg/m2(AT 50/75) Therapy– 21 day cycle

Regimen

00423a

Treatment of Locally Advanced or Metastatic Breast Carcinoma.

Eribulin Monotherapy

Regimen

00228a

Treatment of locally advanced or metastatic breast cancer which has progressed after at least one chemotherapeutic regimens for advanced disease. Prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting unless patients were not suitable for these treatments.

Fulvestrant Monotherapy

Regimen

00361a

Treatment of postmenopausal women with oestrogen receptor positive, locally advanced or metastatic breast cancer for disease relapse on or after adjuvant anti-oestrogen therapy.

00361b

Treatment of postmenopausal women with oestrogen receptor positive, locally advanced or metastatic breast cancer for disease progression on or after adjuvant anti-oestrogen therapy.

Gemcitabine and Carboplatin (AUC2) Therapy - 21 days

Regimen

00430a

Treatment of locally recurrent metastatic triple negative breast cancer.

Paclitaxel Monotherapy 80mg/m2-7day cycle

Regimen

00226a*

Treatment of metastatic breast carcinoma (mBC) in patients who have either failed or are not candidates for standard, anthracycline-containing therapy.

Tamoxifen

Regimen

00253b

Treatment of oestrogen receptor positive advanced breast cancer in pre- or post-menopausal women.

Intravenous Vinorelbine Therapy-21 days

Regimen

00232a

Advanced breast cancer.

Oral Vinorelbine Monotherapy-7days

Regimen

00259a

Advanced breast cancer.

*Unlicensed indication. See protocol for more details.

Advanced Regimens

Protocol Name Indication

Bevacizumab 10 mg/kg - 14 days

Regimen

00212c

In combination with paclitaxel is indicated for first-line treatment of adult patients with HER2-negative metastatic breast cancer.

Bevacizumab 15 mg/kg – 21 days

Regimen

00215e

In combination with paclitaxel is indicated for first-line treatment of adult patients with HER2-negative metastatic breast cancer.

Trastuzumab Emtansine (Kadcyla®)-21 days

Regimen

00206a 

Treatment of adult patients with HER2-positive, unresectable locally advanced or metastatic breast cancer who previously received trastuzumab and a taxane, separately or in combination.

Patients should have either:

  • Received prior therapy for locally advanced or metastatic disease, or
  • Developed disease recurrence during or within six months of completing adjuvant therapy.

Trastuzumab Subcutaneous_21 days - Metastatic Breast Carcinoma

Regimen

HER2 positive metastatic breast cancer (MBC)

00272a

As monotherapy for the treatment of those patients who have received at least two chemotherapy regimens for their metastatic disease. Prior chemotherapy must have included at least an anthracycline and a taxane unless patients are unsuitable for these treatments. Hormone receptor positive patients must also have failed hormonal therapy, unless patients are unsuitable for these treatments.

00272b

In combination with paclitaxel for the treatment of those patients who have not received chemotherapy for their metastatic disease and for whom an anthracycline is not suitable.

00272c

In combination with docetaxel for the treatment of those patients who have not received chemotherapy for their metastatic disease.

00272d

In combination with an aromatase inhibitor for the treatment of postmenopausal patients with hormone-receptor positive MBC, not previously treated with trastuzumab.

Capecitabine Monotherapy

Regimen

00216a

Treatment of patients with locally advanced or metastatic breast cancer after failure of taxanes and an anthracycline containing chemotherapy regimen of for whom further anthracycline therapy is not indicated.

00216b*

First line treatment of metastatic breast cancer or locally advanced breast cancer in a patient for whom anthracyclines and taxanes are contraindicated, or where the side effect profile and/or treatment delivery concerns would favour initial use of capecitabine.

Cyclophosphamide (oral) Methotrexate and 5-Fluorouracil (CMF) Therapy

Regimen

00377b

Metastatic breast carcinoma.

Cyclophosphamide (IV) Methotrexate and 5-Fluorouracil (CMF) Therapy 21 day

Regimen

00381b

Metastatic breast carcinoma.

Cyclophosphamide (oral) Methotrexate and 5-Fluorouracil (CMF) Therapy 28 day

Regimen

00378b

Metastatic breast carcinoma.

Docetaxel Monotherapy 100mg/m2 - 21 day cycle

Regimen

00202a

Treatment of patients with MBC.

DOXOrubicin 50mg/m2/Docetaxel 75mg/m2(AT 50/75) Therapy– 21 day cycle

Regimen

00423a

Treatment of Locally Advanced or Metastatic Breast Carcinoma

Epirubicin 75 + Cyclophosphamide (EC75) Therapy

Regimen

00263a

Metastatic breast carcinoma.

Eribulin Monotherapy

Regimen

00228a

Treatment of locally advanced or metastatic breast cancer which has progressed after at least one chemotherapeutic regimens for advanced disease. Prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting unless patients were not suitable for these treatments.

Everolimus and Exemestane  Therapy

Regimen

00322a

Treatment of hormone receptor-positive, HER2/neu negative advanced breast cancer, in combination with exemestane, in postmenopausal women without symptomatic visceral disease after recurrence or progression following a non-steroidal aromatase inhibitor.

Exemestane Monotherapy

Regimen

00376c

Advanced breast cancer after relapse or disease progression, in women with natural or artificially induced postmenopausal endocrine status.

Fluorouracil + Epirubicin 50 + Cyclophosphamide (FEC50) Therapy

Regimen

00269a

Metastatic breast carcinoma

Lapatinib and Capecitabine

Regimen

0217a

Treatment of adult patients with breast cancer, whose tumours overexpress HER2 in combination with capecitabine for patients with advanced or metastatic disease with progression following prior therapy, which must have included anthracyclines and taxanes and therapy with trastuzumab in the metastatic setting.

Letrozole Monotherapy

Regimen

00371c

Advanced breast cancer after relapse or disease progression, in women with natural or artificially induced postmenopausal endocrine status.

Nab-Paclitaxel (Abraxane®) Monotherapy – 21 day cycle

Regimen

00230a

Treatment of metastatic breast cancer in adult patients who have failed first-line treatment for metastatic disease and for whom standard, anthracycline containing therapy is not indicated.

Pegylated Liposomal Doxorubicin (CAELYX) ® 28 days

Regimen

00205a

Monotherapy for patients with metastatic breast cancer.

Pertuzumab + Trastuzumab + Docetaxel

Regimen

00204a

Treatment of adult patients with HER2- positive MBC or  locally recurrent unresectable breast cancer, who have not received previous anti- HER2 therapy or chemotherapy for their metastatic disease.

Trastuzumab (IV) Monotherapy - 7 days

Regimen

00201a

The treatment of patients with HER2 positive metastatic breast cancer (MBC).

*Unlicensed indication. See regimen for more details.